College of Pharmacy Achieves Record Licensing Exam Success

It would seem that the combination of an increasingly difficult licensing test combined with the COVID-19 pandemic would create the perfect storm preventing pharmacy graduates from passing the North American Pharmacist Licensure Exam, also known as the NAPLEX.

But a faculty and staff task force at the UArizona College of Pharmacy found a way not only to hold off a declining pass rate, but also to help students achieve a first-time pass rate of 94.85%, 10 percentage points better than 2018. In addition, the pass rate was 6 percentage points higher than the national average.

The key to success? Identifying outside factors that were hindering students and creating tools to help them improve their performance. 

Responding to Change

In 2016, the National Association of Boards of Pharmacy (NABP) changed the exam that evaluates the general practice knowledge and licensure eligibility of recent Doctor of Pharmacy graduates. The exam is one of the key components of the licensure process and is used by the boards of pharmacy to assess a candidate’s competence to practice as a pharmacist.

“We wanted to come up with something that was a happy medium while providing flexibility for some personalization.”Ashely Campbell, PharmD, assistant professor and member of the NAPLEX task force

The NAPLEX became a fixed-form exam, increasing the number of questions from 185 to 250 and the duration of the test from 4.5 hours to 6. These and other changes correlated with a decline in pass rates nationwide with the average reaching below 80% in 2017, the first year after the changes went into effect.

The College of Pharmacy was not immune to these declines and sought to identify ways they could help their graduates achieve success on the newly structured test.

“I created a task force to help us diagnose what was happening and to determine how we could fix it,” said Terri Warholak, PhD, assistant dean of academic affairs and assessment for the college. “I wanted to make sure we were taking into consideration several points of view and experiences and speaking to people who had graduated from different schools of pharmacy.”

The task force, a group of faculty and staff members from across the college, noticed several themes that were associated with poor NAPLEX performance, including study skills that did not promote long-term memory, cramming for the exam, and a general lack of time as well as a framework for studying four years’ worth of material. The group also reached out to their peer institutions to see what had been successful elsewhere and what they should avoid.

“We heard everything from schools having one study session at the very end of fourth year to requiring monthly exams throughout the student’s fourth year,” said Ashley Campbell, PharmD, assistant professor and a member of the NAPLEX task force. “We wanted to come up with something that was a happy medium while providing flexibility for some personalization.”

Members of the task force included Campbell; Terri Warholak, PhD; Nancy Alvarez, PharmD; Caitlin Cameron, PharmD; Barb Collins, MS; Janet Cooley, PharmD; Lisa Davis, PharmD; Jeannie Lee, PharmD; Aaron Middleton, PharmD; Marian Slack, PhD; Amy Kennedy, PharmD; and Liz Coronado.

Working Smarter

Beginning 2018, the task force began addressing these issues through a variety of strategies. They first developed resources to educate students on study skills that helped to increase long-term memory. The team also moved the pre-NAPLEX practice exam up from the students’ fouth year to their third. This change gave the students a self-assessment tool early on to help inform their study plan and identify areas needing improvement.

“We wanted them to be able to reflect on their performance areas for growth and to be thinking about how they want to implement a study plan for their fourth year,” explained Dr. Campbell. “And ideally to be able to align that study plan with their fourth-year rotations to get them excited about it, too.”

The task force also obtained funding through the dean’s office to provide the RxPrep program to all fourth-year students. The program includes a comprehensive study guide, 88 online review lecture videos and a 3,000-item test.

In the first year of the project, students were encouraged to study using RxPrep, but that was not mandatory or tied into their graduation requirements. That year, pass rate scores increased by more than 3 percentage points, a significant jump. Still, the task force knew more could be done.

In 2019, the group set a designated study schedule for students for the year before the exam, used the RxPrep test bank to create tests covering the most missed topics on the NAPLEX exam, and established points for passing each review exam to ensure accountability. The new requirements meant that students were held accountable for reviewing the content much earlier in the year and in a testing format that resembled the NAPLEX.

The new approach helped to successful connect the real-world experience students were facing during their rotations with the didactic coursework they had covered previously.

“For certain Advanced Pharmacy Practice Experience rotations, I would review relevant RxPrep chapters. When it was closer to my NAPLEX test date, I reviewed biostatistics, calculations and any other topics that I felt I needed to brush up on,” said Ann Shangraw, PharmD, from the class of 2020. “I liked the practice questions because during your APPE rotations you basically go a year without completing an exam. It was nice to test myself in terms of knowledge and speed.”

“I think the RxPrep program was extremely beneficial,” said Hunter Hoffman, PharmD, also from the class of 2020. “It was nice to have a succinct book with all of the knowledge in one place to refer to as opposed to having to go through all of my old notes.”

While the college is celebrating the students’ unprecedented success on the exam, the task force and Dr. Warholak have set their sights on a new goal. “We don't want to get complacent over where we are right now,” said Dr. Campbell. “I think we can celebrate our victories but continue to work toward the goal of a 100 percent first-time NAPLEX pass rate.”